SF26_HHSM-500-2017-00060I.pdf

AWARD/CONTRACT

2. CONTRACT (Proc. Inst. Ident.) NO. 3. EFFECTIVE DATE

5. ISSUED BY CODE 6. ADMINISTERED BY (If other than Item 5)

UNDER DPAS (15 CFR 700)

4. REQUISITION/PURCHASE REQUEST/PROJECT NO.

7. NAME AND ADDRESS OF CONTRACTOR (No., street, country, State and ZIP Code)

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

8. DELIVERY

9. DISCOUNT FOR PROMPT PAYMENT

10. SUBMIT INVOICES

(4 copies unless otherwise specified)

TO THE ADDRESS SHOWN IN

ITEM

CODE

CODE CODE

FACILITY CODE

11. SHIP TO/MARK FOR 12. PAYMENT WILL BE MADE BY

41 U.S.C. 3304 (a) ( 10 U.S.C. 2304 (c) (

13. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 14. ACCOUNTING AND APPROPRIATION DATA

HHSM-500-2017-00060I See Block 20C

ASG - DQC

CMS,OAGM,ASG,DQC

7500 SECURITY BLVD., MS: B3-30-03

BALTIMORE MD 21244-1850

AGG/KWV

Kelley Williams-Vollmer Contract Specialist 410-786-8177

OTHER (See below)FOB ORIGIN X

CODE

N/A

ACCT

DHHS, CMS, OFM, AMG

Div. of Financial Operations P.O. Box 7520 Baltimore MD 21207-0520

See Schedule) )

15A. ITEM NO 15F. AMOUNT15E. UNIT PRICE15D.

UNIT

15C.

QUANTITY

15B. SUPPLIES/SERVICES

Continued

15G. TOTAL AMOUNT OF CONTRACT $0.00

16. TABLE OF CONTENTS

(X) SEC. DESCRIPTION (X) PAGE(S) DESCRIPTION SEC.

A

B

C

D

E

F

G

H

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

SOLICITATION/CONTRACT FORM

SUPPLIES OR SERVICES AND PRICES/COSTS

DESCRIPTION/SPECS./WORK STATEMENT

PACKAGING AND MARKING

INSPECTION AND ACCEPTANCE

DELIVERIES OR PERFORMANCE

CONTRACT ADMINISTRATION DATA

SPECIAL CONTRACT REQUIREMENTS M

L

K

J

I

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

CONTRACT CLAUSES

LIST OF ATTACHMENTS

REPRESENTATIONS, CERTIFICATIONS AND

INSTRS., CONDS., AND NOTICES TO OFFERORS

EVALUATION FACTORS FOR AWARD

OTHER STATEMENTS OF OFFERORS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

X

X

X

X

X

X

X

X

X

X

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PAGE(S)

17. CONTRACTOR' S NEGOTIATED AGREEMENT (Contractor is required to sign this document and return copies to issuing office.) Contractor agrees to furnish and deliver all items or perform all the services set forth or otherwise identified above and on any continuation sheets for the consideration stated herein. The rights and obligations of the parties to this contract shall be subject to and governed by the following documents: (a) this award/contract, (b) the solicitation, if any, and (c) such provisions, representations, certifications, and specifications, as are attached or incorporated by reference herein. (Attachments are listed herein.)

No further contractual document is necessary. (Block 18 should be checked only when awarding a sealed-bid contract.)

documents: (a) the Government's solicitation and your bid, and (b) this award/contract.

sheets. This award consummates the contract which consists of the following in full above, is hereby accepted as to the items listed above and on any continuation including the additions or changes made by you which additions or changes are set forth

Solicitation Number

SEALED-BID AWARD (Contractor is not required to sign this document.) Your bid on18.

20C. DATE SIGNED

(Signature of the Contracting Officer)

20B. UNITED STATES OF AMERICA

20A. NAME OF CONTRACTING OFFICER

19B. NAME OF CONTRACTOR

19A. NAME AND TITLE OF SIGNER (Type or print)

BY

(Signature of person authorized to sign)

19C. DATE SIGNED

BY

STANDARD FORM 26 (Rev. 3/2013)

Prescribed by GSA - FAR (48 CFR) 53.214(a)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

X

Scott Filipovits

CONTRACTING OFFICER WILL COMPLETE ITEM 17 (SEALED-BID OR NEGOTIATED PROCUREMENT) OR 18 (SEALED-BID PROCUREMENT) AS APPLICABLE

TBD

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 129

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HHSM-500-2017-00060I

(A) (B) (C) (D) (E) (F)

Tax ID Number: Not Available

DUNS Number: Not Available

Period of Performance: 09/27/2017 to 09/26/2022

AUTHORIZED FOR LOCAL REPRODUCTION OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110